Posts Tagged 'life in a victorian asylum'

Life in a Victorian Asylum 3: Patient Rights

It’s easy to assume that, once inside in an asylum, Victorian patients had no rights whatsoever. Many were, however, well able to communicate with the outside world. Letters to the Commissioners in Lunacy or the Home Office – or, in the case of many private patients, their solicitors – were by law to be forwarded unopened. Other letters could be checked by the medical officers, but had to be shown subsequently to the Commissioners, to ensure that this had been done to protect the patient or prevent offence to others: a fine of £20 was payable if letters had been wrongly withheld. Although the decision to withhold letters does seem to have been made fairly often (given the numbers of letters addressed to outside parties pasted into patient records), there are also occasions when patients’ letters appear in the case books alongside a complaint from a relative who has returned them, urging the Hospital to be more strict in their censorship. There was, then, no hard and fast rule as to what was considered permissible.

In January 1895, a middle-aged gentleman by the name of Edward Peter King was admitted to Bethlem. King’s case well illustrates the lines of communication open to an asylum patient in the late nineteenth century. Diagnosed with mania, he was regarded as talkative and troublesome. He was constantly writing letters to the Home Office which, rather to his doctors’ annoyance, were often responded to, making him “more fixed in his idea about his importance & the interest taken in him by the State.” Several months after his admission, King ensured that he received a second medical opinion on his case after writing two letters to the eminent George Savage (a previous Bethlem superintendent) asking him to call, which he did, noting that “at all events I consider him insane as far as CONDUCT is concerned & if at large I believe he will always be getting into scrapes.”

King certainly managed to get into a number of “scrapes” even at Bethlem, apparently irritating his fellow patients by constantly passing wind audibly (on one occasion this so aggravated a Mr Rowland that he threw a book at King, and tried to follow this up with a vase before being stopped by an attendant). On March 8 the Commissioners in Lunacy investigated King’s case, after the patient wrote to the Home Office saying he had not been allowed to visit two dying relatives: a request the Hospital claimed neither the patient nor his relatives had ever made.

With the medical officers checking his post, King made full use of his legitimate channels of communication: the Home Office, the Commissioners in Lunacy, and his solicitor. To the latter, he frequently sent bulky packages, containing letters to be passed on elsewhere (much to the despair of his doctors, who regularly lamented his ingenuity in bypassing their regulations), or advertisements to be placed in the press. In late March, for example, one of these appeared in the Morning Post, asking “parents and guardians” to provide “steady well-educated Young Gentlemen as ARTICLED PUPILS for five years” for a “high-class sixpenny illustrated paper” he wished to start up.

King’s frequent letter-writing was sometimes an embarrassment to the Hospital: in particular, when the patient received a letter from the Home Secretary asking him to give evidence in an enquiry into Holloway Sanatorium, but nothing official was sent to the Hospital. From the tone of the case book, it seems that the medical officers may have found some truth in King’s contention that “the Home Secretary looks upon us [i.e. the Hospital staff] with contempt”.

Edward King was discharged well, just four months after admission, although his life immediately following release does not seem to have been an easy one. It was later recorded that he had spent time in several prisons, and he returned to Bethlem at least once, to try and borrow £1 (which was refused). Although the level of correspondence King maintained while at Bethlem was unusual, his case is a particularly strong example of that way in which, even when certified, a late-nineteenth century patient might still interact to a considerable extent with the world beyond the asylum.

Life in a Victorian Asylum 2: Clerks and Governesses

While certainly connected to moral treatment, improvements at Bethlem were presumably also related to the changing patient profile: throughout the nineteenth century the Hospital became increasingly middle class – by the 1860s, the majority of patients tended to come from lower middle and “educated” working class backgrounds. As Hood lamented in 1854, “The records of all Asylums show how liable are clergymen, authors, artists, governesses, professors and similar persons to be attacked by this terrible calamity. None are more subject to this visitation, none are less able in a pecuniary point of view, to struggle through the trial of such an affliction, yet none are less cared for by the many charitable institutions of our country.” This changing patient profile is indicated in the admissions: 10% of male admissions to Bethlem in 1845-55 were clerks (compared to just 0.01% of the population), while 7% of female admissions were governesses or school mistresses (again, just 0.01% of all women were governesses).

In reflection of this changing class of patient, the Hospital’s wards increasingly came to resemble the Victorian domestic ideal: as the Illustrated London News put it, “that which was once a prison-cell has now become a cheery, domestic room,” while Freeman’s Journal later described photographs of the late nineteenth century hospital as “luxurious” and of “hotel-like magnificence.” This was in line with similar changes described at St Luke’s by Charles Dickens, in his article A Curious Dance Round a Curious Tree. Nonetheless, most contemporary observers were aware that these changes might be little consolation for many patients. As the correspondent from the Illustrated London News concluded: “I thought of the luxuries and the comforts, the plants and the pet animals, the books and the periodicals, the billiard and the ball room, the skill and tenderness of the physician; but all these, to my mind, would not fill up the vast abyss of human mental misery yawning beneath the lofty dome in St George’s fields…”

female ward

Life in a Victorian Asylum 1

Following investigation and subsequent reform in the early half of the nineteenth century (1815 and 1852), Bethlem Hospital increasingly became a very domestic environment, as pictured in the Illustrated London News in 1860. The accompanying article attributed the changes in the Hospital entirely to Bethlem’s new “skilful and benevolent” resident-physician, W. Charles Hood, appointed in 1853; however, the published annual reports show that a large number of changes had already been made under the previous charge of Sir Alexander Morison and Edward T. Monro, the visiting physicians. In 1845, they reported that “much attention has been paid to the amusements of the patients during the past year. The library, billiard and bagatelle rooms are very generally occupied on the male side by the better classes, and much interest excited by books, cards and games.”

These additions to activities in the Hospital, and improvements in the therapeutic environment, were continued by Hood, who adhered strongly to the twin ideals of moral treatment (cure through re-education, with a clear emphasis on environmental and occupational, rather than strictly medical, therapies) and non-restraint (complete abandonment of any type of mechanical restraint, including straps, straight-waistcoats etc. Seclusion, however, was permitted).

male ward